Mental Health Quality and Safety Board minutes: December 2020

Attendees and apologies

Attendees:

• Clare Haughey, Chair- Minister for Mental Health 
• Hannah Axon, Policy Manager, COSLA (also representing for SOLACE’s interests)
• Dr Jane Cheeseman, General Adult Consultant Psychiatrist (IPCU) and Quality Improvement Lead for Lothian Mental Health, Royal College of Psychiatrists
• Ruth Stocks, ACP-UK Director and representative for Scotland Association of Clinical Psychologists
• Ross Sanderson, Policy Officer, Royal College of Nursing
• Ruth Glassborow, Director of Improvement Support and ihub, Healthcare Improvement Scotland
• Julie Paterson, Chief Executive, Mental Welfare Commission
• Irene Oldfather, Director of Strategy and Engagement, Health and Social Care Alliance
• Gordon Johnston, lived experience representative, VOX
• Martin McKay, Secretary, Grampian Health Branch, UNISON
• Angie Woods, Chief Officer for Aberdeenshire Health and Social Care Partnership, representative for IJB Chief Officers

Officials in support:

• Donna Bell, Director for Mental Health and Social Care
• Hugh McAloon, Deputy Director, Adult Mental Health
• Laura Farquhar, Head of Care, Quality and Standards Unit
• Alastair Cook, Principal Medical Officer
• Anne Armstrong, Mental Health Nursing Advisor
• Stephen McLeod, Professional Advisor
• Cara Rosie-Cameron, Senior Policy Officer, Quality, Scrutiny and Assurance Team
• James Niven, Team Leader, Quality, Scrutiny and Assurance Team
• Germaine Vonhof, Team Leader, Clinical Care Policy
• Stephanie Cymber, Senior Policy Officer, Clinical Care Team
• Rebecca Dey, Policy Officer, Clinical Care Team
• Luska Jerdin, Head of Performance, Remobilisation and Renewal
• Siobhan Mackay, Head of Workforce, Digital and Primary Care

Apologies:

• Theresa Fyffe, Scotland Director, Royal College of Nursing
• Michelle Miller, Improvement Adviser and Portfolio Lead: Dementia and Mental Health, Healthcare Improvement Scotland
• Willie Duffy, Secretary and Head of Bargaining for Health, UNISON
• Carol Potter, NHS Fife Chief Executive, representative for territorial NHS Board Chief Executives
• Dr Munro Stewart, Royal College of General Practitioners
• Mark Richards, Director of Nursing and AHPs; Deputy CEO, The State Hospitals Board for Scotland Scottish, Executive Nurse Directors

Items and actions

Welcome and introductions - Minister for Mental Health

The Minister welcomed everyone to the meeting, and thanked them for attending and their hard work throughout a difficult year. The Minister summarised the purpose of the board and provided a brief reminder of the first meeting in February 2020. This second meeting would provide an opportunity to consider how the board can meet the aims of ensuring high quality and safe services in the context of remobilisation and renewal of services, particularly in light of the COVID-19 Pandemic. 

Revisiting the Quality and Safety Board: quality and safety in a post-covid landscape - Laura Farquhar, Anne Armstrong and Stephen Mcleod

Laura Farquhar provided a summary of the original purpose of the Board and the connection to the independent inquiry on mental health services in Tayside, led by DR David Strang. Laura explained that as a result of COVID-19, the context and landscape have changed with The Scottish Government having worked with stakeholders to develop the Transition and Recovery Plan, published in October. Laura outlined the key priorities and commitments of the Transition and Recovery plan.

Anne Armstrong gave an update on governance and assurance around health and social care, in particular, talking about the principles of the Clinical and Care Governance Framework. She spoke about the existing mechanisms for scrutiny and assurance including the organisations involved who have a role in scrutiny and assurance. 

A key focus of this board will be to understand what we are doing in the scrutiny and assurance landscape and what we can do better. The lack of quality standards for mental health services were highlighted as a significant gap in improving the scrutiny and assurance of mental health services. Laura outlined that quality standards would: 

• set out to individuals, their families and carers what they can expect from a mental health service, ensuring a person-centred approach is at the heart.
• give ability to provide assurance against the quality standards.
• opportunity to build a collective understanding of performance against standards
• reduce scope in unwanted variation of quality of care
• provide a basis for continual improvement

The quality and safety board will be instrumental in deciding how we prioritise this work.  

Laura Farquhar highlighted other existing standards and specifications which could be drawn on for this intended work.  Stephen Mcleod provided a case study of the CAMHS service specification and highlighted that subsequent improvements included workforce development, improved access to resources and an increased amount of support for young people and families.  It was agreed that the service specification would be circulated to the board for information. (AP2.01)

Work is also currently underway in primary care mental health with a  Short Life Working Group exploring what success looks like, while it was suggested that this board would have the opportunity to focus on secondary and specialist mental health care. Laura concluded by highlighting the five themes the Board are to consider: Scrutiny and Assurance; Quality Standards work; Data and Evidence; Improvement; Reviewing Assurance and Scrutiny of Mental Health Services 

Discussion - led by Hugh McAloon

The board were largely in agreement in regards to the purpose of the board and priorities.  The below points were raised in the discussion as meriting consideration and focus on by the board:

• agreement that this Board would want to prioritise the development of standards in relation to secondary and specialist mental health services
• the importance of clear care pathways so that individuals understand their rights and what they can expect from services
• attention should be given to how scrutiny and assurance are presented to people using services in a meaningful way
• the differences across the country in terms of access to services was highlighted as an area which could be improved, with a particular emphasis on how this has been impacted by COVID-19
• it was highlighted that there is often a temptation to look at the needs of people already in the services, instead of people who aren’t in the system and are possible struggling to access services
• in discussions around “what good looks like”, board members noted that the focus should be wider than just better mental health services, we should focus better mental health for all people. We need to improve services, in order to improve people’s mental health. Consideration of transition and communication between services will be important here
• outcomes were discussed and the importance of these being qualitative and person-centred, not just inputs and outputs e.g how often. Measurement was highlighted as crucial and the importance of data in enabling longitudinal tracking of patients’ outcomes
• the importance of relationships was highlighted as pivotal to this work, which includes the importance of strong leadership,  people who deliver and work in mental health services, as well as service users
• it was agreed that there needs to be clear stance on governance and protecting staff and service users, which will in turn enhance professionalism. Governance should have a clear improvement focus and provide staff with the support and development that they are required to do their jobs
• there was discussion around the need for a resilient workforce, but an understanding this is not possible without the right structures in place, for example staffing levels and capacity
• the board agreed that there also needs to be consideration towards inequalities and how these can be reduced
• there needs to be sufficient mental health subject matter expertise feeding in at a senior level around leadership and governance.  Internal mechanisms for assurance need to be a focus
• it was noted that the Royal College of Psychiatrists were developing a  paper on ‘what does good look like’, much of this has been reflected in this discussion including pathways of care, outcomes and improvement work
• members of the board were in favour of using methods of coproduction to develop quality standards, to include user groups and individuals involved in mental health services. Work is also needed to ensure staff are listened to and buy into the process
• members also spoke of organisational culture and the impact this can have on any improvement work
• it was emphasised that we cannot underestimate the last 9-10 months and the impact this has had on the population. There is now an increase in need for stronger mental health services as a result of COVID-19

Renewal plan for Scotland’s mental health services - Alastair Cook 

Dr Alastair Cook, Principal Medical Officer for Psychiatry, outlined the work underway on the development of the renewal plan for mental health services as well as how that work – and the work already discussed– will inform the terms of reference and ambitions of the Board. This work will focus on secondary mental health services and is a commitment within the Transition and Recovery Plan. Luska Jerdin from Scottish Government Mental Health Performance,  Remobilisation and Renewal unit will be invited to a future meeting to provide an update on this work. 

Terms of reference and membership - Laura Farquhar 

Laura Farquhar explained there would be an opportunity to review the role of the Q and S Board to ensure it meets not only its original purpose, but support the needs of services through remobilisation and renewal. 

Discussion - led by Hugh McAloon

The board agreed that the Terms of Reference were broadly correct with just one suggestion that we may need to consider including a definition of where the board sits in relation to mental health delivery and other governance mechanisms. (ASP2.02)

The board also agreed that the core membership was mostly correct, but with the opportunity for other stakeholders to be invited if and when the opportunity arose. Members however agreed that a representative from chief Social Workers should be part of the core memberships (AP2.04) as well as consideration for further representation for carers. There was also a suggestion that the voice of Children and Young People should be included, as well as communities and individuals who are harder to reach. 

Lastly, it was agreed that the board would meet again in Early 2020 and dates would be sent to all members in the coming days. (AP2.05)

AOCB and closing remarks – Minister for Mental Health

The Minister provided a summary of the key points discussed and actions that would be taken forward. Board members were thanks for their attendance. 

Actions

• circulate CAMHs service specification - completed
• update terms of reference - terms of reference have been updated. The SG MH Strategy and Co-ordination Unit are undertaking a governance mapping exercise, which will help further establish the role of the board
• invite representative from Chief Social Workers - completed
• consideration for further representation for carers - completed
• possible dates for next meeting to be circulated - completed